#MEDICAID PAY IT DOWN CRACK#

Medicaid is financed partly by the federal government and partly by the individual states. Richman later took a job as head of PhiladelphiaвЂ™s mental health department, where she spent years devising a system to use Medicaid to help address that failure. But the states never committed enough money to that effort, and Richman saw more people with mental illness or disabilities living on the street as a result. вЂњInstead, the 1980s brought the criminalization of the mentally ill and the homelessness epidemic.вЂќД¬ommunity-based housing for people with mental illness was largely left to the states to develop with money saved by closing asylums. вЂњThere would have been billions of dollars more that would have flowed to the states and would have created a much sturdier community support network for patientsвЂ™ housing and employment and clinical services,вЂќ he said. (Even today only one in four people who qualify actually get rental assistance because HUD doesnвЂ™t have the money.) At the same time, the Reagan administration repealed the Mental Health Systems Act, cutting funding that was intended to help build community mental health centers and pushing progress back by decades, said Steve Sharfstein, former director of Mental Health Service Programs at the National Institute of Mental Health.

But in the 1980s, President Ronald Reagan slashed that by more than 70 percent.

HUD was also created in 1965, with a budget that soon grew to $26 billion. Nor would it pay to house people elsewhere, prohibiting the use of federal Medicaid funds for room and board. But, reflecting the concerns of the time, MedicaidвЂ™s creators were adamant that the program would not cover long-term stays in psychiatric hospitals or other institutions, with the exception of nursing homes. The federal Supplemental Security Income program was created to provide a basic income for people with disabilities, while Medicaid, created in 1965, paid for their health care. As deinstitutionalization gained momentum, an infrastructure to help care for people in their communities was supposed to emerge in its place. For years, federal policies had encouraged the closure of state institutions, notorious for warehousing people with mental illness in wretched conditions. In the late 1980s, Richman was tasked with closing the state psychiatric hospital in Philadelphia. Philadelphia undertook one of the earliest experiments in transforming Medicaid funds into support for housing. ItвЂ™s an appealing option for states because unlike rental assistance from HUD, Medicaid is an entitlement, and its budget expands to accommodate everyone who qualifies. Some states, like Arizona, have shown remarkable success by using state Medicaid funds for supportive housing, and they are now asking permission to use federal Medicaid money, too. It has encouraged more state Medicaid programs to cover housing-related costs like furniture or security deposits - basically everything except paying the rent. In the last decade Medicaid has inched toward acknowledging the interconnectedness of housing and health. But some argue that it has a role to play because the health issues of the chronically homeless canвЂ™t be treated without stable housing. The government-funded health insurance for people with low incomes and disabilities was not intended to provide housing. Between 20, chronic homelessness declined by a third.ДЇaced with this HUD funding gap, some local officials are eyeing an unlikely source: Medicaid. Bush and Barack Obama put money into creating more supportive-housing beds, and since 2007, when the government started keeping track, the number nationwide has more than doubled. People are considered chronically homeless if they have a documented disability - including mental illness or addiction - and have been without housing for at least a year.

Being on this list made Hightower eligible for something called supportive housing, which combines services like counseling and job training with keys to a home.ДЇor decades, research has shown that this combination of housing and services is the most effective way to provide for people experiencing chronic homelessness, who make up about a quarter of the nationвЂ™s homeless population and have the most acute needs. Hightower, who is now 39, was on a list he didnвЂ™t know existed: the homeless people in Philadelphia most frequently found in the cityвЂ™s shelters or jail cells. Then one day, in May 2019, an outreach worker for a local nonprofit offered him a way out: an apartment of his own, no strings attached.

#MEDICAID PAY IT DOWN CRACK#

Addicted to crack cocaine and struggling with clinical depression, he cycled in and out of jail and temporary rehab programs, returning to the streets each time he was released. Living on the streets, Hanif Hightower learned which Philadelphia shelters were likely to have an open bed during the cold months or where he could get a meal or a hot shower.

Medicaid pay it down